Chronic pain isn't as compelling as heart disease and cancer. To be a pain patient, in some cases, is to be viewed as an aspiring junkie. Pain has not been recognized with sufficient seriousness.
That is due, in part, to abuse of OxyContin, a powerful painkiller that disappeared from Canada on March 1 and was replaced with a chemically identical but tampering-resistant version called OxyNEO.
Drug users crushed and snorted OxyContin, dubbing it "hillbilly heroin." Annual prescriptions for oxycodone (the generic name for OxyContin/OxyNEO) increased nearly 80-fold since the drug was introduced in 2000, suggesting too many were taking it for too long. Last year, 1.6 million prescriptions were filled.
Though governments moved to slow the prescriptions, reducing the cost to drug plans, they may have unwittingly exacerbated the problems of an estimated seven million serious chronic-pain sufferers across Canada.
Many pain patients have trouble finding doctors to accept them in their practice; as with many others who have chronic ailments, their medical issues take more time and energy than most. They are sometimes seen as potential drug abusers.
Getting rid of OxyContin doesn't end the problem. Other pain medications aren't necessarily benign. The journal Pediatrics last week revealed that children – two Canadians and one American – died after being prescribed codeine-based painkillers after surgery. They overdosed on morphine due to a common genetic trait that leads some to metabolize codeine ultra-rapidly, so that it reaches toxic levels – which suggests that health providers need more education on pain prescribing.
The reality is that pain medications are useful only a third of the time. Thoughtful clinicians such as John Clark, professor of anesthesia at Dalhousie University in Halifax, recognize patients need other treatments and techniques including physiotherapy and group programs.
Dr. Clark wants to see a national pain strategy that, among other things, would encourage more research and help ensure health professionals have more training in pain management, are aware of alternative treatment options and allow patients equal access to care.
As he put it after meeting The Globe's editorial board last week: "We need to get pain on the map."